Certificate, Annotations, and Extensions Application

Use this form to apply for the following programs:

Advanced Certificate in Early Intervention Specialist
Bilingual Education Extension
Gifted Education Extension
Interdisciplinary Autism Program (I-SPAN)
Literacy Post-Masters Certification
Teaching Students with Severe or Multiple Disabilities Annotation
TESOL Post-Masters Certification

Student Information

First Name

Preferred Name

Last Name

Birthdate - used for record validation

Gender

Email Address

Permanent Mailing Address

Country

Street

City

Region

Postal Code

Mobile Phone

Primary Cititzenship

Are You a Permanent Resident?

Graduate Program Application Information

Start Term

Program

Undergraduate College/University

Undergraduate Program Major

Undergraduate Graduation Date

Graduate College/University (if applicable)

Graduate Program Major (if applicable)

Graduate Program Graduation Date (if applicable)

Please indicate if you are an employee or member of a partner organization

Proof of New York State Teacher Certification

Bilingual Extension Statements

Rather than the personal statement, applicants to the Bilingual Extension should write two, different personal/professional statements: Each should be one-page, typed, double spaced, 12 point font, with one inch margins.

Select from the topics below. One of your selected statements is to be written in English, the other is to be written in Spanish. The choice as to which topic will be addressed in each language is yours.

Upload your statements by clicking the "Browse" button in each section.

Statement 1: Discuss how you might use the biligual extension with your current certification and how you might serve English language learners.

Statement 2: You may select one of the following two topics:

What do you consider to be your greatest strengths as a teacher? How do these qualities nurture bilingual students?

OR

Describe an experience you have had that reflects a Spanish speaking culture.

Upload a Professional Statement:

Please tell us why are interested in pursing this program/coursework

To the best of my knowledge, the information I have given in this application is true. I understand that misrepresentation of facts on this application will be cause for admission denial, cancellation of admission or suspension from the institution. By signing this application, I agree to abide by the written policies and regulations of the institution.

Name (electronic signature)

Nazareth University

Certificate, Annotations, and Extensions Application